Study objective: To evaluate early clinical experience with anidulafungin.
Design: Retrospective cohort study.
Setting: Large, university-affiliated, tertiary care medical center.
Patients: All patients receiving anidulafungin between July 15, 2006, and January 15, 2007.
Measurements and main results: Thirty-five patients received at least one dose of anidulafungin. Safety and tolerability were evaluated in all patients; efficacy outcomes were assessed in 13 patients who had a documented fungal infection and received anidulafungin for a minimum of 5 days. Common conditions at baseline were hepatic dysfunction (25 patients [71%]), severe sepsis (17 patients [49%]), and solid organ or hematopoietic stem cell transplantation (10 patients [29%]). Eight patients (23%) were receiving drugs with the potential to interact with echinocandins other than anidulafungin. Seventeen (49%) of the 35 patients received anidulafungin as empiric antifungal therapy. Anidulafungin was used to treat invasive candidiasis in seven patients (20%) and candidemia in 10 patients (29%); Candida albicans or Candida glabrata was isolated most frequently in these two infections combined (7 isolates each [41%]/17 infections). A favorable efficacy outcome was noted in 10 (77%) of 13 evaluable patients. One patient developed breakthrough Candida parapsilosis fungemia while receiving anidulafungin. Overall, anidulafungin was well tolerated, with only one patient having an infusion- related reaction. Anidulafungin was also well tolerated among patients receiving concomitant metronidazole.
Conclusion: Anidulafungin was well tolerated and produced favorable outcomes in the majority of the patients evaluated. The availability of anidulafungin makes it a feasible option for antifungal therapy, particularly in patients who have hepatic dysfunction and in those who are receiving drugs than can interact with other echinocandins.